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Copyright © 2003, Rev 2005 American Academy of Pediatrics Copyright © 2003, Rev 2005 American Academy of Pediatrics Pituitary releases prolactin and oxytocin. Stimulation of nerve endings in mother’s nipple/areola sends signal to mother’s hypothalamus/ pituitary. Hormones travel via bloodstream to mammary gland to stimulate milk production and milk ejection reflex (let-down). Infant suckles at the breast. Copyright © 2003, Rev 2005 American Academy of Pediatrics Maternal Factors That Support Optimal Lactation Normal breast anatomy Intact neuroendocrine reflex Good general health and nutritional status Effective support system Copyright © 2003, Rev 2005 American Academy of Pediatrics Nutrition During Lactation Generally healthy diet Drink fluids to thirst Adequate protein and calories Calcium Multivitamin supplement Copyright © 2003, Rev 2005 American Academy of Pediatrics Maternal Medications Most are compatible with breastfeeding. Medication use in pregnancy is not the same as medication use in lactation. Weigh benefits against risks. Copyright © 2003, Rev 2005 American Academy of Pediatrics Maternal Medications Choose the safest drug available. Prescribe medications for the shortest length of time appropriate. Use short-acting formulations. Administer just after breastfeeding. Monitor infant for side effects. Report adverse effects to the proper authorities. Copyright © 2003, Rev 2005 American Academy of Pediatrics Maternal Medications References AAP Committee on Drugs Hale: Medications and Mothers’ Milk Lawrence and Lawrence: Breastfeeding: A Guide for the Medical Profession Briggs, Freeman, and Yaffe: Drugs in Pregnancy and Lactation Lactation Study Center Drug Data Bank, University of Rochester, NY Copyright © 2003, Rev 2005 American Academy of Pediatrics Breastfeeding Counseling Advise moderation in caffeine intake Avoid alcohol Encourage smoking cessation or limited use Copyright © 2003, Rev 2005 American Academy of Pediatrics Human Milk Colostrum Present in small volume before delivery and in first days after delivery High in host defense proteins and immunoglobulins Transitional milk Copyright © 2003, Rev 2005 American Academy of Pediatrics Human Milk Colostrum Present in small volume before delivery and in first days after delivery High in host defense proteins and immunoglobulins Transitional milk Mature breastmilk Copyright © 2003, Rev 2005 American Academy of Pediatrics Twins Premature infant breastfeeding breastfeeding Photo © Nancy Wight, MD, FAAP Photo © Ruth A. Lawrence, MD, FAAP Copyright © 2003, Rev 2005 American Academy of Pediatrics Breastfeeding Positions Mother comfortable Infant head in straight line with body Tummy-totummy or chest-to-chest Photo © Ruth A. Lawrence, MD, FAAP Copyright © 2003, Rev 2005 American Academy of Pediatrics Cradle Position Copyright © 2003, Rev 2005 American Academy of Pediatrics Cross-cradle or Transitional Position Photo © La Leche League International Copyright © 2003, Rev 2005 American Academy of Pediatrics Side-lying Position Photo © Roni M. Chastain, RN Copyright © 2003, Rev 2005 American Academy of Pediatrics Clutch or Football Position Photo © Lori Feldman-Winter, MD, MPH, FAAP Copyright © 2003, Rev 2005 American Academy of Pediatrics Latch Stimulate rooting reflex. Take sufficient areola into mouth. Flange lips around the breast— “fish lips.” Have wide angle at corner of mouth. Illustration by Tony LeTourneau Copyright © 2003, Rev 2005 American Academy of Pediatrics